Stair-step flap for secondary lower lip revision after lip and cheek composite defects reconstruction.

Abstract

Free flap reconstruction is a common procedure for through-and-through lip and cheek complex defects after cancer ablation. However, oral incompetence with unacceptable bulky flap appearance invariably occurs and needs a secondary revisionary procedure. The purpose of this article was to present our method to improve the oral competence and cosmetic appearance by the stair-step technique of flap revision. Fourteen patients who had undergone flap folding reconstruction of the lip and cheek complex defect resulting in oral incontinence were involved in this study. Thirteen patients had been treated with an anterolateral thigh flap and 1 patient had been treated with a fibular osteocutaneous flap. This revisionary stair-step technique was combined with simultaneous liposuction of the bulky flap in all cases. Adequate oral continence and good contour was achieved in 12 patients. The remaining 2 patients still had mild drooling, which was managed successfully with a second stair-step flap. This technique is a valuable option for revision of lower lip deformity.